Abstract 11031: Renal Function as Predictor of Mortality in Patients after Percutaneous Transcatheter Aortic Valve Implantation
Introduction: Acute kidney injury (AKI) occurs in up to 20% of all patients undergoing cardiac surgery (depending on the definition) and is associated with substantial morbidity and mortality independent of all other factors. Evidence is growing that renal function may also be major predictor of mortality in patients after transcatheter aortic valve implantation (TAVI).
Hypothesis: The aim of this study is to determine the influence of baseline renal function and peri-procedural AKI on prognosis after TAVI.
Methods: TAVI was performed with the 18F-CoreValve™ prosthesis via transfemoral access. All-cause mortality was determined 30 days and 6 months after TAVI. A total of 46 patients unsuitable for open heart surgery with a mean logistic EuroSCORE of 27.6 ± 18.0 % underwent TAVI.
Results: Overall procedural success rate was 100% without periprocedural deaths. 30-day mortality was 13%, 6-month mortality was 24%. 48 hours after TAVI, a significant decrease of serum creatinine (P<0.001) and increase of estimated glomerular filtration rate (eGFR) (P=0.002) in survivors compared to non-survivors was observed. AKI which was significantly associated with the development of a systemic inflammatory response syndrome (P=0.006) occurred in 12/46 patients: 8 patients (67%) died during follow-up. In multivariate analysis, chronic obstructive pulmonary disease (HR 4.3, 95% CI: 1.2–15.0; P=0.02), impaired renal function at baseline reflected by serum creatinine ≥1.42 mg/dL (HR 5.0, 95% CI: 1.4–18.5; P=0.02) or eGFR ≤44.8 mL/min (HR 4.3, 95% CI: 1.3–14.0; P=0.02), and the occurrence of AKI (HR 11.7, 95% CI: 2.9–47.9, P=0.001) were independent predictors of 6-month mortality after TAVI. Conlusions: Impaired renal function at baseline is associated with a higher mortality risk in TAVI patients. However, the occurence of peri-procedural AKI is the strongest predictor of 30-day and 6-month mortality after TAVI – independent whether renal function returns to baseline or not.
- © 2010 by American Heart Association, Inc.